Mandibular Advancement Devices - is your mouth supposed to be closed ?

[Sleepster]

I got a SomnoGuard AP MAD and 2 days ago went to get it adjusted for me to my ENT. Yesterday I tried it for the first time and I couldnt fall asleep with it because I had a feeling that my mouth was full of saliva which I couldnt swallow, which was uncomfortable. 

Sounds like it wasn't adjusted properly.

But I just started sleeping through the full night with the CPAP 2 weeks ago roughly, so its not easy to stop now since its already making a difference.

If the CPAP machine is working for you then I would stick with that and forget about the mandibular device. A huge part of overcoming obstructive sleep apnea is adaptation. If you try switching back and forth you can't adapt.

MAD's are less effective than CPAP therapy (statistically speaking) and are really only for people who can't or won't tolerate CPAP therapy.

The other advantage to CPAP therapy is that you can use your computer to look at the data it generates and use it to determine if your CPAP therapy is effective, and to make adjustments to the CPAP machine to improve the effectiveness of your therapy.

Do you really do that much traveling that taking your CPAP machine with you is a burden? It doesn't count towards your carry-on luggage limit.

[ardenum]

I did recommend narval to you but you have to know, I use a mad together with a machine and a full face mask. On it's own it was not able to resolve my obstructive apneas. It did help me reducing them by about 20% (when used together with cpap)

[vrapche031]

I do a fair amount of weekend trips and I dont want to carry it everywhere with me.especially because sleeping with it without my cpap pillow is absolutely crappy. 

And I can get this for free, so no point in not giving it a go and getting that as well if it helps. I will definitely stick with CPAP though, no intention to stop

[delta]

I have never seen a mandibular advancement device satisfactorily resolve obstructive sleep apnea, and know them to be expensive torture devices designed to extract the maximum amount of cash from your bank account while delivering suffering, pain and poor sleep.

Sleeprider, you got my word out of my mouth. These devices depend greatly on the anatomy and on the manufacturer skill ( I mean the technician that gets yur dental mould and builds your device exactly upon your teeth). And they are pretty expensive, even the no-name ones (on amazon from $20).

I tried some self moulding ones (thermoplastic) and they did not worked at all - they slide and went away during the night, unless I wear a chin strap -this was a solution, as I have OOSA; I think it`s because of the mandible going back too much (and progressively as I realised). And of course, the fat collar...

I consulted a colleague orthodontist (I myself am a phisician) and the consclusion was that even a $250 customized MAD has similar issues, even the silicone material is the same or similar.

Plus: the cause of the mandible getting back and obstruating the airways is the bad occlusion and the bad positioning of the lower teeth, so the logical way, to do the right thing first is to correct their position wearing a brace for a year and a half - "This is the way"

You cannot expect to corect the recess of mandible using a device that by leaning on your lower teeth protrude them even more forward (that`s what a MAD do, it pushes your mandible forward by pushing your lower incissives, and thus rising your occlusion point, the point where your front teeth meet). A phisiological mould would grip the molars instead of pushing the incissives, but thermoplastic is not hard enough to hold the molars, polyurethane, polycarbpnate or other plastics should be used, and the orthesis should "snap" in place on your molars. And could be even more painfull, depending on how strong your parodontal ligaments are (If you have parodonthosys, you`ll lose them).

I consulted a BMF surgeon (they are dentists and surgeons at the same time) if he could adjust my mandible surgically. Yes, an expensive, and a very as in VERY difficult opperation with a lenghty recovery, that I could not have anyway because it`s something wrong with my TMA, the mandible developed an assimetry, consequence of the bad teeth occlusion untreated during childhood with a brace. Sometimes it hurts in the morning and sometimes there is a position that has to be overcome in order to be able to close my mouth. So it`s definitely something wrong with my ATM, but no one of my colleagues, the orthodentist nor the surgeon, did comment on that. I`m an internist, and I care about thinghs that are not internal, I can`t see why they just ignored the fact the ATM is malfunctioning as it had nothing to do with the bad occlusion or the mandible malpositioning.

I myself, as well as many of my patients, are often confronted with such lack of dilligence from doctors. Or at least that it seems - when we don`t know, we usually assume.
Maybe they simply don`t know what can be done, its quite frustrating anyway.

So, the CPAP (with positive expiration presure) is my chosen solution, with all goods and bads. And it kind`a worked the last 2 years - i have 2-3 AHI, but sometimes it feels like I have a debt of sleep. And still sleep the first minute on my pillow. But I can write this now, at 2.13 in the morning, that`s something.

[Sleeprider]

I am flattered that a professional would concur with my uncompromising dismissive statement on the effectiveness of a mandibular advancement dental appliance, and thankful you are not someone making your living by selling them. Clearly we see eye to eye on the need for physicians to LISTEN to their patients. Patinet feedback is meaningful, even if we may disagree; it comes from their experience with their own health. Too many doctors take offense if their expectations that a recommendation they made is not effective or unable to be followed.

My doctor is also an internist, and an open-mined man with in interest in what I have to say. He treats me as an equal and uses my input to design his therapy recommendations. I am invariably open to his recommendations, which come from his experience, education, concern for my well-being and willingness to accept my input. I hope I am able to reflect the same qualities on this forum, and it sounds to me that you do the same in your practice. Give me a shot at your Oscar charts on your own therapy thread, and maybe we can get you to an even better place. Thanks again for the compliment.